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Psychiatry, power and the person

Juliette Brown

Abstract


Psychiatry treats human problems expressed through bodily symptoms and aims to be person-centred, but is often not experienced as such. Experience of mental healthcare care can be profoundly traumatising. The aim of this article is to explore some of the barriers to person-centred care in psychiatry, and to explore ways of integrating the knowledge held by patients with that held by psychiatrists. Barriers include a lack of acknowledgement of the centrality of trauma experiences in the development of mental illness. Other factors include the effects of exposure to psychological trauma as a doctor, being unconsciously motivated by one’s own early life experiences, and internalising the stigma around mental ill-health in patients and in clinicians, as a clinician. The discipline suffers from limitations on the knowledge base. Phenomenological accounts and lived experience research must have higher priority in psychiatric education in order for the discipline to gain both scientifically and ethically. One of the aims of this article is to explore philosophical ideas around reconciliation of apparently opposing narratives and explanatory models in psychiatry, ideas which have the potential to shift power relations and enable renewed focus on what is most meaningful to patients. There is an argument for subjecting psychiatry to ongoing critique of purpose as well as method. In conclusion the form of psychiatry most likely to deliver person-centredness is one that can attend to its own prejudice, its unconscious, its values and those of its subject.

Keywords


Healthcare, person-centred, philosophy, philosophy of medicine, psychiatry, trauma

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References


National Institute for Health and Care Excellence. (2011). Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services Clinical guideline [CG136]. Available at: https://www.nice.org.uk/guidance/cg136/chapter/personcentred-care (last accessed 14 January 2019).

Royal College of Psychiatrists. (2018). Person-centred care: implications for training in psychiatry CR215, September 2018 Available at: https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/college-reports/cr215 (last accessed 14 January 2019).

Bracken, P., Thomas, P., Timimi, S. et al. (2012). Psychiatry beyond the current paradigm. British Journal of Psychiatry 201 (6) 430-434.

Elton, C. (2018). Also Human: The Inner Lives of Doctors. London: William Heinemann.

Ballatt J. & Campling, P. (2011). Intelligent Kindness: reforming the culture of healthcare (Vol. 4). London: Royal College of Psychiatrists Publications.

Herman, J. (1997). Trauma and Recovery. New York: Basic Books.

Van der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.

Garland, C. (2005). Hope and Salutogenesis. Available at: https://abetternhs.net/2018/10/17/hope-and-salutogensis/. (last accessed 23 January 2019).

Tyssen, R. , Vaglum, P. , Grønvold, N.T. & Ekeberg, Ø. (2000), The impact of job stress and working conditions on mental health problems among junior house officers. A nationwide Norwegian prospective cohort study. Medical Education 34, 374-384.

Firth-Cozens, J. (2003). Doctors, their wellbeing, and their stress. It's time to be proactive about stress -and prevent it. British Medical Journal 326 (7391) 670-671.

Chew‐Graham, C.A., Rogers, A. & Yassin, N. (2003). ‘I wouldn't want it on my CV or their records': medical students' experiences of help‐seeking for mental health problems. Medical Education 37, 873-880.

Hillis, J.M., Perry, W.R., Carroll, E.Y., Hibble, B.A., Davies, M.J. & Yousef, J. (2010). Painting the picture: Australasian medical student views on wellbeing teaching and support services. Medical Journal of Australia 192 (4) 188-190.

Billingsley, M. (2015). ‘More than 80% of medical students with mental health issues feel under-supported’. Student British Medical Journal 23, h4521.

Gerada, C. (2017). Doctors and mental health. Occupational Medicine 67 (9) 660-661.

Zigmond, D. (1984). Physician heal thyself: The paradox of the wounded healer. British Journal of Holistic Medicine 1, 63-71.

Stringer, S., Hurn, J. & Burnside, A. (Eds.). (2015). Psychiatry: Breaking the ICE: Introductions, Common Tasks and Emergencies for Trainees. Oxford: Wiley.

Richards, J., Holttum, S. & Springham, N. (2016). ‘How Do “Mental Health Professionals” Who Are Also or Have Been “Mental Health Service Users” Construct Their Identities?’ SAGE Open doi: 10.1177/2158244015621348.

Tomlinson, J. (2017). We Need to Talk about Trauma. Available at: https://abetternhs.net/2017/10/15/we-need-to-talk-about-trauma/ (last accessed 23 January 2019).

Lewis, G. & Apleby, L. (1988). Personality disorder: The patients psychiatrists dislike. British Journal of Psychiatry 153 (1) 44-49.

Chartonas, D., Kyratsous, M., Dracass, S., Lee, T. & Bhui, K. (2017). Personality disorder patients. Still the patients psychiatrists dislike? British Journal of Psychiatry Bulletin 41, 12-17

Main, T.F. (1957). The Ailment. British Journal of Medical Psychology 30, 129-145.

Thornicroft, G., Rose, D. & Mehta, N. (2010). Discrimination against people with mental illness: what can psychiatrists do? Advances in Psychiatric Treatment 16 (1) 53-59.

Gibson, R., Till, A. & Adshead, G. (2018). Psychotherapeutic leadership and containment in psychiatry. British Journal of Psychiatry Advances 25 (2) 133-141.

Firth-Cozens, J. (2003). Doctors, their wellbeing, and their stress. It's time to be proactive about stress - and prevent it. British Medical Journal 326, 670.

General Medical Council. (2018). National Training Surveys 2018 Available at: http://www.gmc-uk.org (Last accessed 5 May 2019).

Balme, E., Gerada, C. & Page, L. (2015). Doctors need to be supported, not trained in resilience British Medical Journal 351, h4709.

Winnicott, D.W. (1965). "Ego distortion in terms of true and false self". In: The Maturational Process and the Facilitating Environment: Studies in the Theory of Emotional Development. New York: International UP Inc.

Craddock, N., Kerr, M. & Thapar, A. (2010). What is the core expertise of the psychiatrist? Psychiatrist 34, 457-460.

Sweeney, A., Clement, S., Filson, B. & Kennedy, A. (2016). “Trauma-informed mental healthcare in the UK: what is it and how can we further its development?” Mental Health Review Journal 21 (3) 174-192.

Mauritz, M., Goossens, P., Draijer, N. & van Achterberg, T. (2013). Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. European Journal of Psychotraumatology 4, doi: 10.3402/ejpt.v4i0.19985.

Harris, M. & Fallot, R. (2001). Using Trauma Theory to Design Service Systems. New Directions for Mental Health Services. San Francisco, CA: Jossey-Bass.

Garland, C. (1998). Understanding Trauma: A Psychoanalytical Approach. London: Routledge.

Stubley, J. (2012). Complex trauma in adults. In: Royal College of Psychiatrists Medical Psychotherapy Faculty Annual Residential Meeting, 19-20 April 2012, Manchester. Available at: http://repository.tavistockandportman.ac.uk/1040/1/Dr%20Joanne%20Stubley.pdf (last accessed 23 January 2019).

Ferenczi, S. (1988). Confusion of Tongues between Adults and the Child. Contemporary Psychoanalysis 24 (2) 196-206.

Foucault, M. (1975). Power relations constituted the a priori of psychiatric practice. In: The Psychotherapy, Neurobiology, Pharmacology Intervention Triangle: the need for common sense in 21st century mental health. Pereira, J.G., Gonçalves, J. & Bizzari, V. (Eds.). Wilmington: Vernon Press.

Bloom, S. & Farragher, B. (2010). Destroying Sanctuary: The Crisis in Human Service Delivery Systems. New York, NY: Oxford University Press.

Coles, S. (2014). “Facing the unspeakable”, paper presented at the Trauma Informed Services: The Future for Mental Health? Conference, Nottingham, 5 November.

Moskowitz, A. (2011). Schizophrenia, trauma, dissociation, and scientific revolutions, Journal of Trauma and Dissociation 12 (4) 347-357.

Dillon, J., Johnstone, L. & Longden, E. (2012). Trauma, dissociation, attachment & neuroscience: a new paradigm for understanding severe mental distress. Journal of Critical Psychology, Counselling and Psychotherapy 12 (3) 145-155.

Tomlinson, J. (2017). We Need to Talk about Trauma. Available at: https://abetternhs.net/2017/10/15/we-need-to-talk-about-trauma (last accessed 23 January 2019).

Anda, R.F., Butchart, A., Felitti, V.J. & Brown, D.W. (2010). Building a framework for global surveillance of the public health: implications of adverse childhood experiences. Preventive Medicine 39 (1) 93-98.

Loughlin, M. (2012). What Person-Centered Medicine Is and Isn’t: Temptations for the ‘soul’ of PCM. European Journal for Person-Centered Healthcare 2 (1) 16-21.

Ratcliffe. M. (2015). Experiences of Depression. Oxford: Oxford University Press.

Fuchs, T. (2013). Depression, Intercorporeality, and Interaffectivity. Journal of Consciousness Studies 20 (7-8) 219-238.

Martin, W., Gergel, T. & Owen, G.S. (2019). Manic temporality. Philosophical Psychology 32 (1) 72-97.

Gold, N., Craigie, J. & Gergel, T. (2017). Interdisciplinary workshop on “mental disorder and self over time”. Journal of Evaluation in Clinical Practice 23 (5) 999-1005.

Callard, F. (2014). Psychiatric diagnosis: the indispensability of ambivalence. Journal of Medical Ethics 40, 526-530.

Corstens, D., Longden, E., McCarthy-Jones, S., Waddingham, R. & Thomas, N. (2014). Emerging Perspectives From the Hearing Voices Movement: Implications for Research and Practice. Schizophrenia Bulletin 40 (Supplement 4) S285–S294.

Fernyhough, C. (2014). The art of medicine: Hearing the voice. Lancet 384, 1090-1091.

Bortolotti, L. (2015). The Epistemic Innocence of Motivated Delusions. Consciousness & Cognition 33, 490-499.

Sass, L., Borda J.P., Madeira, L. Pienkos, E. & Nelson, B. (2018). Varieties of Self Disorder: A Bio-Pheno-Social Model of Schizophrenia. Schizophrenia Bulletin 44 (4) 720-727.

Stanghellini, G. & Broome, M. (2014). Psychopathology as the basic science of psychiatry. British Journal of Psychiatry 205 (3) 169-170.

Carel, H. (2018). Phenomenology of Illness. Oxford: Oxford University Press.

Rose, D., Thornicroft, G. & Slade, M. (2006). Who decides what evidence is? Developing a multiple perspectives paradigm in mental health. Acta Psychiatrica Scandinavica. Supplementum 429, 109-114.

Miller Tate, A.J. (2018). Contributory injustice in psychiatry. Journal of Medical Ethics 45 (2) 97-100.

Rashed, M.A. (2018). Madness and the Demand for Recognition: A Philosophical Inquiry into Identity and Mental Health Activism. Oxford: Oxford University Press.

Loughlin, M., Lewith, G. & Falkenburg, T. (2013). Science, practice and mythology: a definition and examination of the implications of scientism in medicine. Health Care Analysis 21 (2) 130-145

Loughlin, M. & Miles, A. (2014). Psychiatry, Objectivity and Realism about Value. In: Alternative Perspectives on Psychiatric Validation. Zachar, P., Stoyanov, D., Aragona, M. & Jablensky, A. (Eds.). Oxford: Oxford University Press.

Pereira, J. G., Goncalves, J. & Bizzari, V. (2018). The Roots and Seeds of Humanistic Psychiatry. In: The Psychotherapy, Neurobiology, Pharmacology Intervention Triangle: the need for common sense in 21st century mental health. Pereira, J.G., Gonçalves, J. & Bizzari, V. (Eds.). Wilmington: Vernon Press.

Fricker, M. (2007). Epistemic Injustice: Power and the ethics of Knowing. Oxford: Oxford University Press.

McCabe R. & Healey P.G.T. (2018). Miscommunication in Doctor-Patient Communication. Topics in Cognitive Science 10 (2) 409-424.

Loughlin, M., Bluhm, R., Buetow, S., Borgerson, K. & Fuller, J. (2017). Reasoning, evidence, and clinical decision‐making: The great debate moves forward. Journal of Evaluation in Clinical Practice 23, 905-914.




DOI: http://dx.doi.org/10.5750/ejpch.v8i3.1865

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